Abstract

Summary
Background: Globally, Public-Private Mix (PPM) models of service delivery are recommended as a strategy for improving
tuberculosis (TB) control. Several models of PPM-DOTS have been initiated under the Revised National TB Control
Programme (RNTCP) in India, but scaling up and sustaining successful projects has remained a challenge.
Aim: This paper examines factors accounting for the sustainability of a PPM-DOTS initiated in 1998 in Pimpri Chinchwad
(PC), a city in Maharashtra, India.
Methods: A two-year intervention research project documented the workings of the PPM–DOTS programme. This paper
draws on in-depth interviews with programme officers and staff, and semi-structured interviews with private practitioners
(PP) practising in the study area.
Results: PPM-DOTS was originally introduced in PC, in order to increase access to DOTS. Over the years it has become
an integral part of the RNTCP. Multiple approaches were employed to involve and sustain private providers’ participation
in PPM-DOTS. Systems were developed for supervision and monitoring DOTS in the private sector. Systematic use of
operations research and successful mobilisation of available local resources helped set future direction for expanding and
strengthening the PPM. The private sector’s contribution to case detection and treatment success has increased, however
ensuring referrals of TB suspects from all private providers continues to present a challenge.
Conclusion: PPM-DOTS in PC is one of the few Indian models implemented as envisaged by global and national policy
makers. Its successful operation for over a decade reiterates the importance of public sector initiative and leadership and
makes it an interesting case for study and replication.